Stigma Surrounding Physician Suicides Means Many Go Unreported

When I was a resident, I came home from a swing shift in May to the smell of gasoline wafting through the entryway of my home. I immediately knew something was wrong and anguish gripped me. I opened the door to the garage and turned on the light to find my fiancé dead on the floor. He had killed himself using the exhaust fumes of his motorcycle.

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My fiancé’s death occurred 20 years ago, but little has changed regarding the stigma and silence that surrounds suicide, especially among physicians. We have known since 1977 that, on average, the United States loses the equivalent of a large medical school class each year to suicide.1

A study in 2000 showed that although physicians were less likely than non-physicians to die from heart disease or cancer, they are more likely to die of suicide. This study estimated that 400 physicians die each year due to suicide, and most feel this number is grossly underestimated.2 Female physicians are at more risk than their male colleagues, with a 2.27 times higher rate of suicide compared to the general female population, but male physicians are also at risk, with a 1.41 higher rate than their non-physician counterparts.3

Suicide is frequently the result of untreated or undertreated depression or another mental illness that may be complicated by substance abuse and/or dependence, with the deadly combination of knowledge of and access to lethal means. Depression is at least as common in physicians as in the general population, where the prevalence is 7 to 8 percent, and a recent study suggests that the incidence in emergency physicians may be much higher, with 18.5 percent of attendings and 47.8 percent of residents reporting symptoms of depression.4 Prevalence of substance abuse disorders among physicians during the span of their careers is similar to that of the general population, with a rate of 10 to 12 percent.5 With regard to knowledge and access to lethal means, there is no doubt that physicians understand the physiology of death and have more access to lethal means than the general population, as evidenced by their higher success rate at committing suicide.3

Compounding the problem is that physicians are often unwilling to seek help for their mental health or substance abuse problems due to the stigma surrounding these issues. Fears regarding privacy, confidentiality, and how knowledge of their problem might affect their future career often dissuade physicians from seeking help. Physicians who successfully took their own lives were less likely to have received mental health treatment when compared to a similar cohort of non-physicians.6

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Thank you for this timely and reasonable article. The stigma is sadly still a very large problem for the entire House of Medicine.

It would be really nice if someday in the distant future the act of voluntarily seeking help would no longer be mandated for disclosure on forms for employment and hospital privileges. I am fine with keeping involuntary confinement within the realm of mandatory disclosure. Treat that similarly to DUI, as both potentially endanger the public and cast doubt on the judgement of the practitioner to know what is best for themselves and others. But a voluntary hospitalization, pursued by the doctor themselves, is an act of consent to medical care which should be protected under HIPAA. A voluntary psych hospitalization says that the person consenting to care is acting in the interest of themselves and their community and has the capacity to know that this consent to care is the right thing to do. Which is the whole point of this discussion.

Mandatory disclosure, in my opinion, also treads upon the spirit of the Americans with Disabilities act. There have been various takes on this law, but last I heard it is meant to allow employees to work in a reasonable environment and accomplish their work tasks if generally left unmolested and with reasonable customary accommodations. If an employee generally appears to be a fairly close approximation of what was expected in the job description, the employer in my opinion has no preexisting right to scrutinize medical records. This protection should be extended to the psychiatric realm.

Doctors with mental illness have to feel it is less risky to get care than to avoid it for us to ever stop dying at a higher percentage rate than the general population.

I am not an attorney. This is not legal advice. These are my opinions. They are not the opinions of either Schumacher Clinical Partners, TeamHealth, Erx Group or any affiliated organizations or agents.

I’m sick of this conversation. Very few physicians/medical groups, academic institutions, etc. are taking the lead on addressing this issue because it is distasteful. We know it exists, we don’t like to talk about it. It is a perceived weakness, an Achilles heel if you will, within our medical ranks. If we were serious about addressing it, the first place to begin would be the application process. I agree with the comment which stated that by requesting such information be provided, they are violating HIPPA laws. It would be enough to ask if one possesses a medical or psychiatric condition that would affect their ability to care for patients. If the concern is that the individual will lie, well, they can lie about having seizures as well. What’s to prevent a doctor with that particular diagnosis, who happens to be a surgeon, from having a seizure during a procedure and endangering the patient? Basically, what is the difference?

Two residents kill themselves in New York within a week of each other in 2014 and it causes concern. My residency in Emergency Medicine was in New York. A third year surgical resident was terminated from his position. He was accepted at another residency in anesthesiology. Within a month he was dead by suicide. His death has bothered me ever since. That was 1997-1998. 2015 ACGME holds their first wellness conference? What took so long?

There is, in fact, a physician who is actively speaking on this issue and assisting physicians/medical students and residents in addressing their depression or suicidal thoughts. Giving them tools. Speaking out. Her name is Pamela Wible, M.D. I’ve sent a letter to ACEP requesting this physician be invited to speak at our yearly conference. No response to my letter.

The suggestions made in the article have been suggested thousands of times before. Until they are taken seriously, they are rhetorical. Written fodder.